One disadvantage of the Aspirex device is that blood is extracted during thrombectomy. Prolonged aspiration may potentially cause hemodynamic deterioration in patients with PE-related shock. In patients with a massive thrombus load, prolonged thrombectomy may be required to reverse cardiogenic shock but may result in significant blood loss. In this situation, transfusion of 1 or 2 units of packed red blood cells may be necessary.